Child's Information

Please enter the name of the child attending camp. A separate registration form for each child is required.

Address *

Country

City

State

Zip code

Phone *

Email *

(parent's/guardian's email)

Child's Age: *

Select which age applies as of July 2015

Does your child: *

Church Name:

(If you attend one regularly)

Volunteer Opportunity

Yes, I would like more information about volunteering

Please check if you would like information on volunteering to help at Camp. This includes any older siblings who would be willing to help.

Health Information

Alberta Health Number *

Allergies:

Please list any allergies your child has. If none, leave blank.

Emergency Contact Information

Name: *

Phone: *

Relation to Child: *

Name: *

Phone: *

Relation to Child: *

Parent Information & Permission

Name(s) of Parent(s)/Guardian(s) with whom child lives *

Permission/Waiver *

I agree

I give permission for my child to participate in the Chaparral T-ball camp July 13-16, 2015, 2:00-3:30 pm at the ball diamond by St. Sebastian School in Lake Chaparral (Field B3CHA02). I understand that this program is run by Southwinds Church, and that the program is conducted by the church and its volunteers and staff. I am aware that my child is participating voluntarily and is doing so at his/her own risk and Southwinds Church, its members, agents or volunteers, are not liable for any loss, damage, death, injury or ambulance service resulting from or in connection with such participation. I understand that my child\'s picture will be taken and may be used for promotional material both printed and online. By agreeing with this statement and submitting this form to Southwinds Church, I accept the terms and conditions stated herein.

Payment

Payment Instructions

Cost is $60 per child. Once this form is submitted you will be automatically directed to a link for online payment. Registration will not be submitted until payment is complete through PayPal. Credit Cards are accepted, however you may be required to set up a basic PayPal account as per PayPal’s terms.

Limited Registration

Registration is limited and will be filled as registrations are received.
Any questions, please contact Holly at 403-404-9920 or email at hollyprocita@southwindschurch.ca